Is the Climb Worth the View? The Savings/Alert Ratio for Reducing Vitamin D Testing

Area of Science:

• Clinical Laboratory Science
• Health Informatics
• Medical Decision Making

Background:

• Vitamin D testing has increased significantly, despite existing guideline recommendations.
• Inappropriate laboratory testing remains a challenge in healthcare settings.
• Clinical decision support (CDS) systems offer a potential solution to mitigate unnecessary laboratory orders.

Purpose of the Study:

• To evaluate the effectiveness of a CDS system in reducing inappropriate 25-hydroxyvitamin D assay orders.
• To assess the impact of electronic alerts on provider ordering behavior for vitamin D testing.
• To quantify the cost savings associated with the implementation of a CDS intervention.

Main Methods:

• A CDS intervention was implemented at Vanderbilt University Medical Center, delivering electronic alerts to providers for potentially inappropriate 25-hydroxyvitamin D orders.
• The study involved an 80-day observation period, comparing an intervention group receiving alerts with a control group.
• Data collected included the number of tests ordered, provider information, and patient demographics.

Main Results:

• The intervention group, exposed to alerts, showed an 8% absolute reduction in vitamin D testing compared to the control group.
• Providers receiving alerts completed 25-hydroxyvitamin D orders in 89.9% of encounters, versus 98.1% in the control group.
• Each alert display resulted in an average reduction of $14.70 in charges and $0.34 in laboratory spending.

Conclusions:

• The implemented CDS effectively reduced vitamin D test ordering through a soft-stop alert mechanism.
• The study introduces the savings/alert ratio as a metric to evaluate the impact and comparability of such interventions.
• Electronic alerts are a viable strategy for optimizing laboratory test utilization and achieving cost efficiencies.